Not usually a problem unless the patient has a reduced conscious level (a late sign of serious organ failure).

The patient may present with:

• Raised respiratory rate and/ or breathlessness. This can be due to compensation for metabolic acidosis or may be due to fluid overload.

• On auscultation: bi-basal fine crackles or reduced breath sounds at the bases if developing fluid overload.

The patient may present:

• hypotensive and tachycardic as a result of hypovolaemia/ shock

• Other signs of this will include dry mucous membranes, cool peripheries, delayed CRT, decreased skin turgor

• The patient may feel thirsty

• Peripheral oedema if developing fluid overload

• low urine output, concentrated urine

The patient may present:

• drowsy or with new confusion due to the accumulation of urea or drugs

• headaches or lightheadedness due to hypovolaemia

• May have a distended/ palpable bladder if outflow obstruction

• May present with abdominal or flank pain if presenting with intrinsic renal pathology